A Long Term Story with Long Term Impacts…
Long term residential care experiences some unique issues, in addition to the standard demographic challenges and cost pressures faced by all healthcare organizations. Care groups may have one or a few, hundreds, or thousands of homes across multiple countries with residences varying in number of beds and patient care needs. The geographically dispersed perspective presents a unique challenge for consistency and calls for strong staffing governance. In these environments there is an opportunity to sustain consistent and standardized approaches given the organization ability to maintain consistency in many areas across residences. Given the achievement of 5-star quality ratings and alignment with government requirements such as Payroll Based Journals are critical to the business, strong governance over shift planning, resource deployment, and workforce scheduling is critical. Here’s an example of how we can help:
Sitting just below the absence of common governance over the scheduling functions, our client had a history of challenges in maintaining schedules for their facilities. Although schedules were based on standard templates for similar-sized facilities there was a pattern of employees swapping shifts at the last minute. This resulted in a vicious circle or domino effect of new requests for leave, followed by additional swap requests, driving new leave requests, and so on. Each site did not have a scheduler to fill empty shifts, although some homes did have their receptionist cover this role. This resulted in a high degree of variance across buildings. Sites that had staffing issues and were under-performing but were perplexed as most of them had some sort of clock in and clock out system. However, central timekeeping was overwhelmed with inquires after each pay period from employees who were underpaid, and it is easy to project that a similar number of employees were overpaid. Many of the staff hired as care aides were unable to get the hours they needed to live. They had to supplement their income by working at multiple homes outside of the organization, and sometimes outside of healthcare altogether.
In this situation the priority solution was to design and implement stronger governance and to formalize it alongside the implementation of new vacation planning and approval guidelines and cleaner reporting. The current metrics that came flying in each week from a centralized reporting division were understood by the Executive Directors, but not by the manager responsible for most of the leave approvals. Standard business processes were designed with an eye to reinforce the new governance model. The business processes clearly outlined responsibilities for staff, managers, and the scheduling function. One new process on shift swaps included timeframes on requests and approvals to ensure requests were made in advance and to reduce the panic of approving or denying last-minute requests. This helped managers make better informed less reactive decisions. Staff were encouraged to better plan their schedules in advance, to be more accountable, and to submit availability for additional shifts.